Fill this in once. Every check-in outcome then takes your real history into account, not just this week's answers.
This stays private to you. Your employer never sees it. It is only included in a handover to occupational health if you say yes at the bottom of this page.
Choose any that apply, or leave them all unticked.
I'm having treatment, therapy or waiting for it
My treatment or medication affects how I do my job
I've had this same issue before
Include this background if I'm referred to occupational health
Your background changes how urgent a suggestion is — it never produces a diagnosis, and no one is told about it without your say-so.